Análise da variabilidade da frequência cardíaca na síndrome dos ovários policísticos

Conselho Nacional de Desenvolvimento Científico e Tecnológico

Síndrome metabólica e fatores associados: estudo comparativo com mulheres que apresentaram pré-eclâmpsia e gravidez normal, acompanhadas cinco anos após o parto

Preeclampsia is defined as an extremely serious complication of the pregnancy-puerperium cycle with delayed emergence of cardiovascular risk factors, including metabolic syndrome. The research aimed estimate the prevalences of metabolic syndrome and associated factors in women with preeclampsia and normal pregnancy followed five years after childbirth. This is a cross-sectional observational study using a quantitative approach, conducted at a maternity school in the city of Natal in Rio Grande do Norte state. The sample was composed of 70 women with previous preeclampsia and 75 normal selected by simple random probability sampling. Subjects were analyzed for sociodemographic, obstetric, clinical, anthropometric and biochemical parameters. International Diabetes Federation criteria were adopted to diagnose metabol ic syndrome. The Kolmogorov-Smirnov, Mann-Whitney, Student s t, Pearson s chi-squared, and Fisher s exact tests, in addition to simple logistic regression, were used for data analysis, at a 5% significance level (p &#8804; 0.05). Statistical tests demonstrated elevated body mass index (p = 0.001), predominance of family history of diabetes mellitus (p = 0.022) and significantly higher prevalence of metabolic syndrome in the preeclampsia group (37.1%) when compared to normal (22.7%) (p = 0.042). Intergroup comparison showed a high number of metabolic syndrome components in women with previous preeclampsia. Altered systolic and diastolic blood pressure (p < 0.001) was the most prevalent, followed by low concentrations of high-density lipoproteins (p = 0.049), and hyperglycemia (p=0.030). There was a predominance of the metabolic syndrome in women with schooling 0-9 years (42.4%) (p = 0.005), body mass index above 30Kg.m 2 (52.3%) (p < 0.001), uric acid high (62.5%) (p = 0.050 and family history of hypertension (38.5%) (p< 0.001). Multivariate analysis of the data showed that the body mass index above 30 kg.m2, education level less than 10 years of study (p < 0.001) and family history of hypertension (p = 0.002) remained associated with the metabolic syndrome after multivariate analysis of the data. It is considered Women with previous preeclampsia exhibited high prevalence of metabolic syndrome and their individual components in relation to normal, especially, altered systolic and diastolic blood pressure, low concentrations of high-density lipoproteins and hyperglycemia. The factors associated to this ou tcome were obesity, less than 10 years of schooling, and family history of hypertension. Overall, this study identified young women with a history of PE exposed to a higher cardiovascular risk than normal

Avaliação multidimensional de pessoas idosas atendidas por equipes de saúde da família em Natal-RN: uma análise demográfica e epidemiológica

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior

Associação entre consumo alimentar e atividade física com a síndrome metabólica em mulheres na pós-menopausa

Post-menopause is characterized as the period beginning one year after the permanent cessation of menstrual cycles, which is typically related to medical disorders that, in association with Metabolic Syndrome (MS), represent a set of cardiovascular risk factors. Objective: To assess dietary intake and the prevalence of metabolic syndrome in postmenopausal women, according to the level of physical activity. Methods: The sample consisted of 82 women, evaluated in the Northern Zone of the city of Natal / RN who were participants in the Natal Active Program. People completed a Food Frequency Consumption Questionnaire (FFCQ) and were interviewed about physical activity. Anthropometric measurements and biochemical tests were used to diagnose MS (Metabolic Syndrome). Result: The active women consumed more protective foods (flaxseed, nuts, whole wheat bread, brown rice and olive oil) than inactive women. Risky foods (sugar, crackers, white bread, white rice, margarine and beef) were consumed more by the group of inactive women. The prevalence of MS was higher in inactive women (53.30%) than in physically active women (46.70%). Conclusion: Active post-menopausal women had a higher daily intake of protective foods in relation to cardiovascular disease, while the inactive post-menopausal women had higher intake of risky foods for such diseases

Doença periodontal e angina pectoris estável: um estudo caso-controle

The search which it aim was to analyze the Periodontal Disease as a risk factor for the development of the Stable Angina Pectoris. For that, 120 patients (52 blokes and 68 wenches ), ages ranging from 40 to 65 years old, and attended to the Hemodinamic´s Sector of the Natal Hospital Center, showing the historic of Angina Pectoris to accomplishment of cinecoronariografhy. Before the accomplishment of this exam, the patients were submitted to interview, to investigate the possible risk factors for the Cardiovascular diseases , and it was followed of clinical periodontal examination to evaluate the presence of Periodontal Disease. After the cinecoronariography, the patients who presented diagnosis of important arterial obstruction (above 70%) were enrolled to the case grup. However the individuals with arteries free of obstruction, or obstrution below 30%, were considered without historic of Cardiovascular disease and therefore enrolled for the control grup. The groups were paired by the variables age and gender. From the analysis of the results, a did not observed statisticment the significant association between the presence of the Periodontal Disease, probing depth, periodontal attachment level, severity and extension index of the Periodontal Disease, besides the visible plaque index (VPI) an gingival bleeding index (GBI) regarding to the existence of Stable Angina Pectoris. Nevertheless , it was identified statisticment the significant association between the sistemic arterial hypertension , seric level of total cholesterol, LDL, HDL and triglycerides, showing all of them, classic risk factors appointed by the literature. Therefore, it was conclued that Periodontal Disease did not represent association with the StableAngina Pectoris at least among the studied population

Tontura em idosos institucionalizados da cidade do NATAL/RN: Um estudo caso-controle em vestibulopatas e não-vestibulopatas

the institutionalized elderly presents for being more fragile a lot of body balance s changes, which can induce falls and health frailty. One of the consequences of it is the appearance of dizziness, vestibular or not. This study aims to identify the risk factors related to dizziness in institutionalized elderly, with and without vestibular disorders, in the city of Natal-RN. Method: a case-control study realized in 12 regulated by Health Surveillance Long Term Care Institutions for the elderly in Natal-RN. Elected seniors with good cognitive level and able to walk, totaling 115 individuals, and of these, 102 were selected according to the presence of dizziness in the last year (n = 51) and their controls (n = 51), paired by sex and age. The 51 elderly patients with dizziness were divided into 3 groups case: case one, for elderly with dizziness and without vestibulopathy (n=38); case two, for elderly with dizziness and vestibulopathy (n=13) and case three, for all the seniors with dizziness, or added to the case 1 case 2 (n=51). The 51 seniors who served as controls were also divided into three groups, according to the number of individuals of each case: control 1, n = 38, control 2, n = 13 control and 3 (sum of 1 control with control 2), n = 51. As possible risk factors were analyzed variables related to characteristics of the institution, to the habits of life of older people and those concerned with the health of the elderly. For statistical analysis, we used the chi-square or Fisher exact test for a significance level of 5% and calculating the association magnitude between variables by measuring the Odds Ratio. Results: as risk factors for dizziness without vestibular disorders were found the presence of hypertension and cardiovascular disease, as well as the presence of three or more disorders for elderly and use of gastric protector drugs. For the elderly group from case two were found no associated risk factor. For elderly patients with dizziness in the case group three, we observed the same risk factors found for the elderly in the case group one, plus the presence of osteoarthritis pathology, which was also significant for this group. Conclusion: dizziness in institutionalized elderly is associated with systemic common diseases in this age group and the vestibulopathy presents itself as pathology on an isolated way, not being possible, with our data, associate it with non-risk factors

Fatores de riscos cardiovasculares em adolescentes da cidade do Natal-RN

Estudos têm demonstrado elevada prevalência de fatores de risco cardiovascular em adolescentes a redor do mundo, entretanto, é possível que esses fatores de risco se comportem de modo diferente em diferentes localidades. Objetivos: Examinar a prevalência do sobrepeso/obesidade e sua associação com outros fatores de risco cardiovasculares, em adolescentes, da cidade do Natal-Brasil. Métodos: Estudo observacional de delineamento transversal, realizado em 626 adolescentes (10 a 19 anos) de ambos os sexos. Foram estudadas as variáveis: peso, idade, gênero, cor, escolaridade, renda familiar, hábitos de vida, história familiar, peso, estatura, índice de massa corporal, relação cintura/quadril, pressão arterial, perfil lipídico, Glicose e Insulina de jejum e pós Dextrosol. Resultados: Foram avaliados 273 (43,6%) adolescentes do sexo masculino e 353 (56,4%) feminino. 26,4% dos adolescentes apresentaram sobrepeso/obesidade. A presença de obesidade familiar foi relatada por mais de 30 % da nossa amostra. Na análise de regressão logística múltipla; Idade, renda familiar, percentil de pressão sistólica, história familiar de hipertensão e obesidade, triglicerídeos, HDL colesterol, e HOMA RI mostraram-se associados com sobrepeso/obesidade. A relação cintura quadril apresentou-se mais elevada nas mulheres, e encontramos 10,9 % dos adolescentes com percentil de pressão sistólica (PAS) 95, e 7,4 % com percentil de pressão diastólica (PAD) 95. As dosagens de triglicerídeos, colesterol HDL e HOMA-RI alterados foram mais prevalentes nos que apresentavam IMC aumentado. As alterações do xi colesterol total, triglicerídios, glicemia pós dextrosol e HOMA teste, tiveram maior prevalência no gênero feminino. Na regressão logística binária, foram observadas associações do sobrepeso / obesidade com idade; OR 0,85, IC de 95% (0,78-0,92); p<0,001, pressão arterial sistólica; OR 2,65, IC de 95% (1,18- 5,94); p< 0,020, renda familiar; OR 2,34, IC de 95% (1,53-3,58); p< 0,001, história familiar de hipertensão arterial; OR 1,76, IC de 95% (1,15-2,71); p< 0,009, história familiar de obesidade; OR 1,50, IC de 95% (1,09-2,27); p< 0,04, aumento dos trigliceridios; OR 2,74, IC de 95% (1,69-4,43); p< 0,001, redução do colesterol; HDL OR 0,58, IC de 95% (0,38-0,87); p< 0,009 e o aumento do HOMA OR 3,16, IC de 95% (1,64 - 6,02); p<0,001. Conclusão: A prevalência de fatores de risco cardiovascular em Natal – Brasil se constitui em grave problema de saúde pública, atingindo níveis que se igualam ou até superam os de outras cidades tanto no Brasil, como em outros países

Determinantes genéticos e ambientais das doenças hipertensivas da gravidez

The development of complex diseases such as preeclampsia are determined by both environmental and genetic factors, but there is also interaction among these factors. Preeclampsia is a pregnancy-specific disorder characterized by de-novo hypertension and proteinuria after 20th week of gestation. There is a broad spectrum of clinical presentations related to hypertensive disorders of pregnancy (HDP) that can range from mild preeclampsia to eclampsia (seizures) or HELLP syndrome (Hemolysis, Elevation of Liver enzymes, Low Platelets). Those clinical outcomes might be linked to different pathological mechanisms. Our work aims to identify factors (i.e. genes and environmental) associated with the HDP’s clinical spectrum. Using a case-control approach, we selected a total of 1498 pregnant women for epidemiological and genetic studies, encompassing 755 normotensive (control); 518 preeclampsia; 84 eclampsia; and 141 HELLP. Women were genotyped for 18 SNPs across 5 candidate genes (FLT1, ACVR2A, ERAP1, ERAP2 and LNPEP). For the environmental factors, we found maternal age, parity status and pre-gestational body mass index as important risk factors associated with disease. Genes were associated in a phenotype-specific manner: ACVR2A with early preeclampsia (rs1424954, p=0.002); FLT1 with HELLP syndrome (rs9513095, p=0.003); and ERAP1 with eclampsia (rs30187, p=0.03). Our results suggest that different genetic mechanisms along with specific environmental factors might determine the clinical spectrum of HDP. In addition, phenotype refinement seems to be an essential step in the search for complex disease genes

Influência de mudanças de fase no ciclo claro-escuro sobre o controle autonômico cardíaco de ratos

Introduction: The circadian system has neural projections for the Autonomic Nervous System (ANS), directly interfering with sympathetic-vagal modulation of the cardiovascular system. Disturbances in the circadian system, such as phase changes in light-dark cycle (LD), has been related to the risk of development of cardiovascular diseases due to increased sympathetic tone and reduction o Heart Rate Variability (HRV - RR intervals). Purpose: Investigate the interaction between Circadian Timing System and cardiac autonomic control in rats. Materials and methods: We used 18 Wistar rats (♀, age = 139.9 ± 32.1 days, weight = 219.5 ± 16.2 g), divided into three distinct groups: Control (CG), phase delay of 6h (GDe) and phase advance of 6h (GAd). Three animals were excluded during data collection (CG/GDe/GAd - n=5). Telemeters were surgically implanted in each animal for continuous acquisition of electrocardiographic (ECG) signals (duration of 21 days in the CG and 28 days in GDe/ GAd). A LD cycle was established 12h: 12h, beginning of light at18:00h and dark at 06:00h. The animals remained in the same CG LD cycle throughout the experimental period, while, on the 14th day of registration, the GDe and GAd underwent a delay and an advance in 6h, respectively. Throughout the experimental period, the locomotor activity (LA), the mean heart rate (mHR) and variables related to iRR [mean RR (mRR), SDNN, RMSSD, LF, HF and LF/ HF ratio ] were recorded. All data were analyzed in blocks of 3 and 7 days, for the presence of circadian rhythm, values of Cosinor - mesor, amplitude and acrophase (paired t test), phase relationship, differences between light and dark (t test independent), averages every 30 minutes along each time series (two-way ANOVA with post hoc Bonferroni). The data block B1,M1 and M2 in CG served as benchmarks for comparisons between series of analysis of the GAT/GAV. Results: We observed circadian rhythmicity in the variables LA, mRR and mFC(p<0.01). mRR and mFC showed phase relationship with the LA in all three groups, being less stable in GAd. In the CG, no significant differences between blocks were found in any of the analyzes(p>0.05). Among the 7 day blocks, there was a significant reduction in mRR(p=0.04) and mFC(p=0.03) in GDe and significant reduction in HF mean(p=0.02) in GAd; and between 3 day blocks, a significant increase of LF/HF(p= 0.04) in the GDe; besides mRR(p=0.03), SDNN(p=0.04), RMSSD (p=0.04), LF (p=0.01) and HF(p=0.02) significant increase in the GAd. It was found that the differences between the means of the mRR, LA and mFC in light and dark phases were not significant after phase changes in some of the blocks/moments (GDe and GAd). No significant results were found when comparing rhythmic variables means every 30 minutes over the blocks, except for a significant decrease in mRR at the middle of the dark phase (B2) and the start of light phase (B3) - (p<0.01). Conclusion: phase advances and delays (6h) altered cardiac autonomic control in the experimental groups by temporarily HRV decrease. Phase advances apparently had greater negative interference in this process, in relation to the phase delays.

Prevalência e fatores associados à diminuição da função pulmonar em obesos em pré-operatório de cirurgia bariátrica

Introduction: Obesity shows changes in pulmonary function and respiratory mechanics, however, little is known regarding the prevalence of worsening respiratory function when considering the increase in central or peripheral adiposity or general obesity. Objectives: To analyze the association between anthropometric adiposity and decreased lung function in obese. Materials and Methods: Patients eligible for this study obese individuals (IMC≥30kg/m2) in pre-bariatric surgery and referred for Treatment Clinic of Obesity and Related Diseases, located at the University Hospital Onofre Lopes (HUOL), from October 2005 and July 2014. The evaluation included clinical information and measurement of anthropometric measures (body mass index (BMI), body fat index (BFI) and waist circumference (WC) and neck (NC)) and spirometric. The prevalence and analysis by Poisson regression was performed considering the following outcome variables: forced vital capacity (FVC), forced expiratory volume in one second (FEV1) and Maximum Voluntary Ventilation (MVV) and as predictor variables were considered: BMI, IAC, WC and NC and as control variables: age, gender, smoking history and comorbidities (diabetes mellitus, dyslipidemia and hypertension). Statistical analysis was performed using Statistical Package for Social Sciences software (SPSS - version 20.0). Results: We analyzed 384 individuals, 75% women, mean BMI: 46.6 (± 8.7) kg/m2, IAC: 49.26 (± 9.48)%, WC: 130.84 (± 16.23) cm and NC: 42.3 (± 4.6) cm. The higher prevalence of FVC and FEV1 <80% was observed in individuals with NC above 42 cm, followed those with a BMI above 45 kg/m2. Multivariate analysis using Poisson regression showed as risk factors associated with FVC <80%, the variables: NC above 42 cm (odds ratio (OR) 2.41) and BMI over 45Kg/m2 (OR 1.71 ). As for FEV1 <80% predicted, all predictor variables were associated, with the largest odds presented by the NC (3.40). MVVV was not associated with any studied varaible. Conclusion: Individuals with NC above 42 cm had higher prevalence of reduced lung function and the NC was the measure with the highest association with reduced lung function in obese.

A influência da perda de peso no perfil inflamatório de mulheres com síndrome dos ovários policísticos

The polycystic ovary syndrome (PCOS) is considered the most common endocrine disorder in reproductive age women, with a prevalence ranging from 15 to 20%. In addition to hormonal and reproductive changes, it is common in PCOS the presence of risk factors for developing cardiovascular disease (CVD) and diabetes mellitus, insulin resistance (IR), visceral obesity, chronic low-grade inflammation and dyslipidemia. Due to the high frequency of obesity associated with PCOS, weight loss is considered as the first-line treatment for the syndrome by improving metabolic and normalizes serum androgens, restoring reproductive function of these patients. Objectives: To evaluate the inflammatory markers and IR in women with PCOS and healthy ovulatory with different nutritional status and how these parameters are displayed after weight loss through caloric restriction in with Down syndrome. Methods: Tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6) and C-reactive protein (CRP) were assessed in serum samples from 40 women of childbearing age. The volunteers were divided into four groups: Group I (not eutrophic with PCOS, n = 12); Group II (not eutrophic without PCOS, n = 10), Group III (eutrophic with PCOS, n = 08) and Group IV (eutrophic without PCOS, n = 10). The categorization of groups was performed by body mass index (BMI), according to the World Health Organization (WHO) does not eutrophic, overweight and obesity (BMI> 25 kg / m²) and normal weight (BMI <24.9 kg / m²). IR was determined by HOMA-IR index. In the second phase of the study a controlled dietary intervention was performed and inflammatory parameters were evaluated in 21 overweight and obese women with PCOS, before and after weight loss. All patients received a low-calorie diet with reduction of 500 kcal / day of regular consumption with standard concentrations of macronutrients. Results: Phase 1: PCOS patients showed increased levels of CRP (p <0.01) and HOMAIR (p <0.01). When divided by BMI, both not eutrophic group with PCOS (I) as eutrophic with PCOS (III) showed increased levels of CRP (I = 2.35 ± 0,55mg / L and 2.63 ± III = 0,65mg / L; p <0.01) and HOMA-IR (I = 2.16 ± 2.54 and III = 1.07 ± 0.55; p <0.01). There were no differences in TNF-α and IL-6 between groups. Step 2: After the weight loss of 5% of the initial weight was reduced in all of the components of serum assessed inflammatory profile, PCR (154.75 ± 19:33) vs (78.06 ± 8.9) TNF α (10.89 ± 5.09) vs (6:39 ± 1:41) and IL6 (154.75 ± 19:33) vs (78.06 ± 08.09) (p <0:00) in association with improvement some hormonal parameters evaluated. Conclusion: PCOS contributed to the development of chronic inflammation and changes in glucose metabolism by increasing CRP, insulin and HOMA-IR, independent of nutritional status. The weight loss, caloric restriction has improved the inflammatory condition and hormonal status of the evaluated patients.

Influência de fatores ambientais na Leishmaniose visceral no Rio Grande do Norte

The Visceral Leishmaniose (LV) disease is endemic in some places in Brazil. It is caused by the protozoa Leishmania chagasi, being transmitted for vector, the phlebotomies, Lutzomyia longipalpis. In virtue of the expansion of the illness in Rio Grande do Norte, it is necessary to evaluate the determinative ambient factors in the proliferation of the vector for better control of the illness. The variable rainfall and the social variables had been analyzed using space regression with two models and the ambient variable of ZANE and the variables analyzed in 205 houses in the cities of Natal, Extremoz, Nísia Floresta, São Gonçalo do Amarante, São Jose do Mipibu, Parnamirim and Macaíba the Person and ML Chi-square were used . The analyses had shown that high rainfall, plain relief, the forest, the humid tropical climate the activities of production culture of sugar cane and fruit culture and the presence of bovines increase the risk of the LV. The work showed that it has space aggregation and that ambient factors influence in the LV in the State

Análise da contribuição de fatores genéticos e ambientais na manutenção da hanseniase nos estados do Rio Grande do Norte e Pará

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior

Prevalência da infecção por papilomavírus humano, herpes simplex tipo 1 e 2 e Chlamydia trachomatis em um segmento da população feminina da grande Natal/RN

Sexually transmitted diseases (STDs) are among the largest public health problems, especially in developing countries. The acquisition of these infections during early sexual activity is common and many infections have a benign course. However, in some pathogens remain in the state of latency can be reactivated and cause productive infection that may progress to severe forms. In addition, some of them are transmitted vertically resulting in congenital infection, causing immediate damage or long-term child. The classic risk factors for sexually transmitted agents are: early onset of sexual and reproductive health, multiple sexual partners throughout life, use of oral contraceptives and co-infections with different pathogens. We present the results of a cross-sectional study aimed to estimate the prevalence of genital infection by human papillomavirus (HPV), Herpes simplex virus (HSV) and Chlamydia trachomatis (CT) in a segment of the female population of the metropolitan area Christmas, among those who enrolled voluntarily sought, Basic Health Units for the examination of cancer screening cervix in the period 2008 to 2010. All participants, a total of 261 women answered a standard questionnaire by which identified the socio-demographic characteristics, classical risk factors for STDs, reproductive and sexual activity and smoking. Of each patient were obtained two samples, one for the completion of the Pap test for detection of cellular changes and the other processed for DNA extraction and analyzed by PCR (polymerase chain reaction) to detect the three pathogens studied. The population of the study was composed of sexually active women aged between 13 and 79 years, mean 38.7 years, most of them being married, low education levels and low incomes. The majority (87%) had normal results on cytology and only 2.7% had low-grade cytological abnormalities. Prevalence rates were 37.9% for HPV, 4.6% for CT and 26% for HSV. HPV prevalence was higher in women under 25, unmarried and in those who had multiple sexual partners. Women with simultaneous infection by HSV-1 and 2 had higher prevalence of HPV infection. The prevalence of HSV infection showed no association whatsoever with the risk factors analyzed and HSV-1 was the predominant type among the cases of genital HSV infection. The overall prevalence of C. Trachomatis was relatively low, thus providing greater value in younger women aged less than or equal to 20 years

Prevalência da infecção genital pelo vírus herpes simples tipo 1 e 2 em mulheres grávidas e não grávidas de Natal/RN

Herpes simplex is a virus that can be transmitted sexually and is potentially associated with vertical transmission. This study evaluated the prevalence of genital infection by herpes simplex virus (HSV) types 1 and 2 in pregnant and nonpregnant care in the city of Natal / RN, including a total of 222 women, 92 pregnant and 130 nonpregnant. The participants answered a questionnaire to obtain data and socio-demographic characteristics, as well as potential risk factors for sexually transmitted diseases. After the interview, we collected two cervical specimens, one for the Pap test and the other for DNA extraction and analyzed by polymerase chain reaction (PCR) to detect both virus serotypes. Then the women underwent a clinical examination by colposcopy. For statistical analysis, we used the chi-square and logistic regression by SSPS 17.0 Statistic. Most women were up to 30 years of age, nonwhite ethnicity, married, elementary education, family income below the poverty level; initiated sexual activity with age up to 18 years; had more than one sexual partner lifelong and was not pregnant, but has had at least one child. The HSV-1 showed a prevalence of 26.1% among pregnant women and 30.0% in non-pregnant women. While HSV-2 prevalence was found with 10.9% and 19.2% in pregnant and nonpregnant women, respectively. The largest proportion of morphological changes of the uterine cervix was detected among nonpregnant women, both in cytology and in colposcopy. The women were nonwhite ethnicity, married, became pregnant aged less than or equal to 18 years and who had one to two pregnancies had a lower risk of acquiring genital HSV infection. There was a high prevalence of genital HSV infection, HSV-1 is more prevalent than HSV-2. No association was found between morphological changes of the uterine cervix and the presence of the virus in pregnant and nonpregnant women, nor between genital HSV infection and the classic risk factors for sexually transmitted diseases